1982760724 NPI number — DR. EDWARD P ROSA MD

Table of content: DR. EDWARD P ROSA MD (NPI 1982760724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982760724 NPI number — DR. EDWARD P ROSA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSA
Provider First Name:
EDWARD
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982760724
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5451 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33067-4641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-757-7672
Provider Business Mailing Address Fax Number:
954-757-7670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5451 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33067-4641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-757-7672
Provider Business Practice Location Address Fax Number:
954-757-7670
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME71617 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111117 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 152284 . This is a "VALUE OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 41672 . This is a "BSBC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5388461 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7351806 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 96273 . This is a "UNITED BEHAVIORAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: COMPSYCH . This is a "259896" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1086806 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 299334 . This is a "HARMONY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: BENESIGHT . This is a "41672" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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